A case of defrauding medical insurance funds "pulled" by a single courier
Yangzi Evening News (correspondent Bian Yuanyuan Yuanyuan reporter Chen Yong) Why do patients send their long-term medicines to other places by express after they are prescribed medicines in the outpatient department of the hospital?
Yangzhou sentenced a case of defrauding medical insurance funds, and 22 defendants were sentenced for fraud.
On the 12th, the reporter learned the details of the case from the Yangzhou prosecutor.
It is reported that this case is the first batch of cases listed for supervision since the Ministry of Public Security launched the "Kunlun 2022" special action.
In April 2019, the Yangzhou Social Insurance Fund Management Center received a report from the public that after kidney transplant patients were prescribed anti-rejection drugs in the outpatient department of Yangzhou Hospital, they were sent to other places by express.
An investigation by the Social Security Center found that Zhao, who was identified by the Social Security Center as an outpatient special disease patient of "anti-rejection treatment after kidney transplantation", purchased relevant anti-rejection drugs from a hospital in Yangzhou with a medical insurance card.
After that, Zhao appeared at a courier station near the hospital, and he sent a courier package marked "medicine", which was signed for in Ma'anshan, Anhui the next day.
The Social Security Center immediately reported the case to the public security organ.
After the incident, the police tracked down 9 people including Zhang, the drug recipient, and 33 drug sellers, including Zhao, through Zhang and others.
The police found out that in December 2017, Zhao underwent a kidney transplant in Nanjing.
After the operation, Zhao needed to take various anti-rejection drugs such as Baixintong, Sirolimus, and Bailing Capsules. The value of the drugs each month was more than 10,000 yuan.
With medical insurance reimbursement, he only needs to pay 2,000 yuan at his own expense.
During the postoperative hospitalization, Zhao saw a small advertisement for high-priced medicines in the public toilet of the hospital.
After being discharged from the hospital, Zhao contacted the recipient on the small advertisement. Under the guidance of the recipient, Zhao took the prescription issued by the doctor when he was discharged from the hospital and went to a hospital in Yangzhou to prescribe medicine.
During Zhao's review, the doctor will issue a new prescription for him according to the changes in his body's drug concentration and condition, and the dosage will gradually decrease.
However, Zhao did not inform the doctor in Yangzhou Hospital of the change in the dosage, but kept using the prescription form when he was discharged from the hospital to make up his actual dosage.
After getting the medicine prescribed by the doctor, he only kept the amount he actually needed, and the extra part was sold to the recipient at a low price.
From the beginning of 2018 to July 2019, Zhao illegally made more than 30,000 yuan in this way.
During this period, Zhao also helped other patients to connect with the drug recipient, defrauding the medical insurance fund of more than 750,000 yuan.
On December 31, 2020, the Hanjiang District Procuratorate prosecuted Zhao and 22 others for fraud.
Recently, the Hanjiang District Court heard the case and pronounced the verdict in court.
(The person involved is a pseudonym)